Presenting the Role of CPOE Incorporating with CDSS in Decreasing the Costs of TPN in   ICU

  • Home
  • Presenting the Role of CPOE Incorporating with CDSS in Decreasing the Costs of TPN in   ICU

Presenting the Role of CPOE Incorporating with CDSS in Decreasing the Costs of TPN in   ICU

1Dr. Elife Ozkan, 2Gizem Uzumoglu, RPh,3Zehra Eraltug, RPh
1,2,3Tire State Hospital, Izmir, Turkey; Ödemiş State Hospital Izmir Turkey; Tepecik Training and Research Hospital Izmir Turkey


ABSTRACT:

Total parenteral nutrition (TPN) is the treatment modality of providing intravenous nutrition for patients who cannot get oral feeding. Physicians use standard scales, such as NRS-2002 and NUTRIC, for TPN orders. The usage of NRS-2002 in public hospitals has been mandatory in Turkey since 2015. The quality management department of Izmir Tire Public Hospital recognized that TPN consumption increased dramatically since 2015. The orders, which increased in direct proportion to the number of patients, showed that it should be investigated by evaluating their necessity according to nutritional practice standards. The objective of this study is to research the effect of e-orders incorporated with a clinical decision support system on TPN consumption. We digitalized the NRS-2002 form and added a clinical decision support system to calculate the score and calorie requirements. We found that the total number of NRS-2002 forms completed by physicians increased by 95%, the number of TPN orders decreased by 41%, and the cost decreased by 38% in 2018. This study showed that e-ordering of TPN combined with a clinical decision support system is beneficial for decreasing costs.

 

KEYWORDS:

Parenteral nutrition (PN), Clinical decision support system (CDSS), intensive care unit (ICU), CPOE, HIMSS, EMRAM

 

REFERENCES :

1) Kraft M, Gärtner S, Simon P, et al. Quality control of parenteral nutrition in hospitalized patients. Nutrition. 2014;30(2):165-168. doi:10.1016/j.nut.2013.07.010
2) Cekmen N, Dikmen E. Yoğun Bakim Hastalarinda Enteral Ve Parenteral Nütrisyon. Toraks Cerrahisi Bul. 2014;5(3):187-197. doi:10.5152/tcb.2014.030
3) Löser C. Malnutrition in hospital: prevalence, clinical consequences and relevant costs. DMW – Dtsch Medizinische
4) Wochenschrift. 2001;126(24):729-734. doi:10.1055/s-2001-15034
5) Bozzetti F. Parenteral nutrition. Nutrition. 2019;66:101-107. 

doi:10.1016/j.nut.2019.03.013
6) Roberts MF, Levine GM. Nutrition Support Team Recommendations Can Reduce Hospital Costs. Nutr Clin Pract. 1992;7(5):227- 230. doi:10.1177/0115426592007005227
7) Elhassan AO, Tran LB, Clarke RC, Singh S, Kaye AD. Total Parenteral and Enteral Nutrition in the ICU: Evolving Concepts.
8) Anesthesiol Clin. 2017;35(2):181-190. doi:10.1016/j.anclin.2017.01.004
9) Worthington PH, Gilbert KA. Parenteral nutrition: Risks, complications, and management. J Infus Nurs. 2012;35(1):52-64. doi:10.1097/NAN.0b013e31823b98ef
10) Crews J, Rueda-de-Leon E, Remus D, Sayles R, Mateus J, Shakeel F. Total Parenteral Nutrition Standardization and Electronic Ordering to Reduce Errors. Pediatr Qual Saf. 2018;3(4):e093. doi:10.1097/pq9.0000000000000093
11) Mummadi SR, Mishra R. Effectiveness of provider price display in computerized physician order entry (CPOE) on healthcare quality: A systematic review. J Am Med Informatics Assoc. 2018;25(9):1228-1239. doi:10.1093/jamia/ocy076
12) Lyons AM, Sward KA, Deshmukh VG, Pett MA, Donaldson GW, Turnbull J. Impact of computerized provider order entry (CPOE) on length of stay and mortality. J Am Med Informatics Assoc. 2017;24(2):303-309. doi:10.1093/jamia/ocw091
13) Balaraman P, Kosalram K. E –Hospital Management & Hospital Information Systems – Changing Trends. Int J Inf Eng Electron Bus. 2013;5(1):50-58. 

doi:10.5815/ijieeb.2013.01.06
14) Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ. 2005;330(7494):765. doi:10.1136/bmj.38398.500764.8F
15) Johnston ME, Langton KB, Haynes RB, Mathieu A. Effects of computer-based clinical decision support systems on clinician performance and patient outcome. A critical appraisal of research. Ann Intern Med. 1994;120(2):135-142. doi:10.7326/0003-4819- 120-2-199401150-00007
16) Alther M, Reddy CK. Clinical decision support systems. Healthc Data Anal. 2015;(May 2014):625-656. doi:10.1201/b18588
17) Sittig DF, Stead WW. Computer-based Physician Order Entry: The State of the Art. J Am Med Informatics Assoc. 1994;1(2):108- 123. doi:10.1136/jamia.1994.95236142
18) Dana T, Talsma A, Nicholas R, Kritine K, Rhonda S. Nursing Medication Administration and Workflow Using Computerized Physician Order Entry. CIN Comput Informatics. 2011;29(7):401-410. doi:10.1097 / NCN.0b013e318205e510
19) Cartmill RS, Walker JM, Blosky MA, et al. Impact of electronic order management on the timeliness of antibiotic administration in critical care patients. Int J Med Inform. 2012;81(11):782-791. doi:10.1016/j.ijmedinf.2012.07.011
20) Chassin MR, Galvin RW. The Urgent Need to Improve Health Care Quality: Institute of Medicine National Roundtable on Health Care Quality. JAMA. 1998;280(11):1000. doi:10.1001/jama.280.11.1000
21) Shu K, Shu K, Boyle D, et al. Comparison of Time Spent Writing Orders on Paper with Computerized Physician Order Entry.
22) Medinfo. 2001;(100):1207-1211. doi:10.3233/978-1-60750-928-8-1207
23) Bates DW, Boyle DL, Teich JM. Impact of computerized physician order entry on physician time. In: Annual Symposium on Computer Applications in Medical Care. American Medical Informatics Association; 1994:996. 

http://www.ncbi.nlm.nih.gov/pubmed/7950101. Accessed August 3, 2019.
24) Kuperman GJ, Gibson RF. Computer Physician Order Entry: Benefits, Costs, and Issues. Ann ofInternal Med. 2003;139:31-39.
25) www.annals.org. Accessed May 12, 2017.
26) Wolfstadt JI, Gurwitz JH, Field TS, et al. The Effect of Computerized Physician Order Entry with Clinical Decision Support on the Rates of Adverse Drug Events: A Systematic Review. J Gen Intern Med. 2008;23(4):451-458. doi:10.1007/s11606-008-0504- 5
27) Eraltug Z, Uzumoglu G, Bolat O, Ozkan E, Aydin N, Kose I. Effect of closed-loop medication administration on medication billing leakage : A case study. 2020;(15).
28) Türkyılmaz C, Bilgen H, Kültürsay N. Turkish neonatal society guideline on the parenteral nutrition in preterm infants. Turk Pediatr Ars. 2018;53:S119-S127. doi:10.5152/TurkPediatriArs.2018.01812
29) Kalender N, Tosun N, Kilic S. Determination of the Level of Knowledge of Nurses Working at an Education Hospital About Total Parenteral Nutrition. Turkiye Klin J Nurs. 2015;7(1):10-19. doi:10.5336/nurses.2013-34534
30) Batu Z, Ustun M. Nütr İ Syon Kilavuzu.; 2016.
31) HIMSS Analytics. Electronic Medical Record Adoption Model. HIMSS Analytics. HIMSS. About. https://www.himss.org/.
32) Kose I, Rayner J, Birinci S, et al. Adoption rates of electronic health records in Turkish Hospitals and the relation with hospital sizes. BMC Health Serv Res. 2020:20:967. doi:https://doi.org/10.1186/s12913-020-05767-5
33) Madden AM, Morgan MY. Resting energy expenditure should be measured in patients with cirrhosis, not predicted. Hepatology. 1999;30(3):655-664. 

doi:10.1002/hep.510300326
34) Trice S, Melnik G, Page CP. Complications and Costs of Early Postoperative Parenteral Versus Enteral Nutrition in Trauma Patients. Nutr Clin Pract. 1997;12(3):114-119. doi:10.1177/088453369701200303
35) Goldstein M, Braitman LE, Levine GM. The Medical and Financial Costs Associated with Termination of a Nutrition Support Nurse. J Parenter Enter Nutr. 2000;24(6):323-327. doi:10.1177/0148607100024006323
36) van Schaik R, Niewold TA. Quality improvement and cost savings by dietitians through follow-up of patients with total parenteral nutrition during hospital admission. ESPEN J. 2014;9(2):e59-e62. doi:10.1016/J.CLNME.2014.02.003
37) Calloway S, Akilo HA, Bierman K. Impact of a Clinical Decision Support System on Pharmacy Clinical Interventions, Documentation Efforts, and Costs. Hosp Pharm. 2013;48(9):744-752. doi:10.1310/hpj4809-744
38) Vermeulen KM, van Doormaal JE, Zaal RJ, et al. Cost-effectiveness of an electronic medication ordering system (CPOE/CDSS) in hospitalized patients. Int J Med Inform. 2014;83(8):572-580. doi:10.1016/J.IJMEDINF.2014.05.003
39) McMullin ST, Lonergan TP, Rynearson CS, Doerr TD, Veregge PA, Scanlan ES. Impact of an evidence-based computerized decision support system on primary care prescription costs. Ann Fam Med. 2004;2(5):494-498. doi:10.1370/AFM.233
40) McMullin ST, Lonergan TP, Rynearson CS. Twelve-Month Drug Cost Savings Related to Use of an Electronic Prescribing System With Integrated Decision Support in Primary Care. J Manag Care Pharm. 2005;11(4):322-332. doi:10.18553/jmcp.2005.11.4.322
41) Okumura LM, Veroneze I, Burgardt CI, Fragoso MF. Effects of a computerized provider order entry and a clinical decision support system to improve cefazolin use in surgical prophylaxis: a cost saving analysis. Pharm Pract (Granada). 2016;14(3):717. doi:10.18549/PharmPract.2016.03.717
42) Jacob V, Thota AB, Chattopadhyay SK, et al. Cost and economic benefit of clinical decision support systems for cardiovascular disease prevention: a community guide systematic review. J Am Med Informatics Assoc. 2017;24(3):ocw160. 

doi:10.1093/jamia/ocw160
43) Plaza V, Cobos A, Ignacio-García J, et al. Cost-effectiveness of an intervention based on the Global INitiative for Asthma (GINA) recommendations using a computerized clinical decision support system: a physicians randomized trial. Med Clin (Barc). 2005;124(6):201-206. doi:10.1157/13071758
44) Cobos A, Vilaseca J, Asenjo C, et al. Cost Effectiveness of a Clinical Decision Support System Based on the Recommendations of the European Society of Cardiology and Other Societies for the Management of Hypercholesterolemia. Dis Manag Heal Outcomes. 2005;13(6):421-432. doi:10.2165/00115677-200513060-00007

  • Share

Leave a Reply

Your email address will not be published. Required fields are marked *